Evidence Checklist: Vocal Cord Paralysis

Laryngoscopy confirming vocal cord immobilityCritical

Flexible laryngoscopy or stroboscopy documenting unilateral or bilateral vocal cord paralysis or paresis, including the position of the paralyzed cord (paramedian, lateral), which affects voice and breathing impact.

Nexus opinion linking vocal cord paralysis to service ("at least as likely as not")Critical

A medical opinion connecting the vocal cord paralysis to an in-service surgical complication (thyroid or cervical surgery), traumatic neck or chest injury, intubation injury, or nerve damage from a service-connected condition.

Speech pathology evaluation with acoustic voice analysisCritical

Formal voice evaluation documenting the degree of hoarseness, breathiness, diplophonia, or aphonia, maximum phonation time, and impact on communication. Objective acoustic measures document severity.

CT or MRI of neck and chest to identify causative lesion

Imaging to identify the underlying cause of paralysis — particularly important for recurrent laryngeal nerve paralysis (CT from skull base to mediastinum) to document service-related pathology.

Documentation of aspiration or dysphagia (if applicable)

Modified barium swallow study or clinical documentation of aspiration or swallowing difficulty, which may occur with bilateral paralysis or high vagal lesions.

Treatment records (voice therapy, medialization, injection laryngoplasty)

Records documenting voice therapy, vocal cord medialization procedures, injection laryngoplasty or thyroplasty, or tracheotomy if bilateral paralysis caused airway compromise.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Completed DBQ Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx, and PharynxCritical

Standardized form capturing laryngoscopy findings, voice quality, aspiration status, and functional impact of vocal cord paralysis.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.